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The Downsides of High Vancomycin Troughs: No Longer ‘Mississippi Mud,’ but Still Hazardous
A retrospective cohort study from a large healthcare system found that elevated vancomycin troughs were common and associated with a higher body mass index and reduced baseline renal function, and led to more acute kidney injury and a longer hospital length of stay.
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Pediatric Pneumonia — Evolving Diagnosis and Management
Tachypnea has long been considered to identify which children with acute fever and cough might benefit from antibiotic treatment, especially in resource-limited parts of the world. Now, with declining rates of vaccine-preventable infections with Haemophilus influenzae and pneumococcus, new data suggest that approximately 90% of febrile, tachypneic, coughing (but still well enough for outpatient treatment) preschoolers do fine without antibiotics.
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Left Ventricular Unloading During Venoarterial ECMO in Cardiogenic Shock
In a series of patients with cardiogenic shock, the use of venoarterial extracorporeal membrane oxygenation with a percutaneous left ventricular unloading device was associated with better-than-expected outcomes.
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Combination Drug Therapy for Hypertension
A large regional database study from Italy demonstrated that initial combination therapy for newly diagnosed hypertension results in fewer major adverse cardiovascular events at one year compared to monotherapy.
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Safety and Efficacy of HEART Score Use in the ED
A prospective observational study of 30-day outcomes in patients with suspected acute coronary syndromes triaged in EDs before and after the implementation of the HEART score showed that there were fewer hospitalizations and a very low risk of death or myocardial infarction among low-risk patients who were discharged without further cardiac testing.
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An Update to the Management of Atrial Fibrillation
This focused update to the 2014 guidelines for the management of atrial fibrillation (AF) includes revisions to anticoagulation recommendations and the role of catheter ablation of AF in patients with heart failure.
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Volume-Outcome Relationship With Newer-Generation TAVR Devices?
This large-scale retrospective analysis of all balloon-expandable transcatheter aortic valve replacement valves revealed no apparent relationship between procedure volume and outcomes after an initial learning curve of 200 procedures.
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Rethinking the Prophylactic Use of Proton Pump Inhibitors in the ICU
The authors of this multicenter, blinded, randomized trial found that among critically ill adults at risk for gastrointestinal (GI) bleeding, fewer patients in the pantoprazole group exhibited clinically important GI bleeding compared to placebo, although mortality at 90 days was similar in both groups.
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Late Awakening Among Cardiac Arrest Survivors Predicts Worse Short- and Long-Term Outcomes
In this retrospective single-center study, late awakening after cardiac arrest was associated with a higher rate of unfavorable outcomes immediately after awakening and at three months.
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Mechanical Circulatory Support for Cardiogenic Shock
Exploring what options exist for temporary percutaneous mechanical support for cardiogenic shock associated with acute myocardial infarction?